Relapse + Recovery

Yesterdays psych session was SO productive. It was something of a shock, considering I was thinking about cancelling as everything was going okay lately.

The main revelation, of sorts, was that I’d been based my fear of relapse on faulty data. The first 2-3 times I was sick I was on the wrong type of meds. SSRI’s did nothing for me. So yes, I did get better and get sick a couple of times but that was completely independent of the medication. A lot of that was circumstantial and I did a good job getting my life in order after each one.

The last relapse took place this year and my brain has been using the following narrative: “I’ve been on 5 different types of medication and have had so many ups and downs. This cycle will be continuing in the future and should be incorporated into any long term planning.”

If you look at it objectively though, it is only the Cymbalta that stopped working. The Effexor was going fine, I only switched brands because I hated the weight gain and lethargy. That was at the start of the relationship with Glenn though so I was putting myself under a lot of pressure.

SNRI’s have actually done pretty well for me and there has only been ONE relapse since I’ve been on them, in the past 6 years. In those years there has been so many stressful things happen. Our family was under a lot of pressure for an extended period of time.

~

It is so helpful to realize this. The fear of relapse, which I believed was incredibly strong, was informing every decision. I’ve been putting so much pressure on myself to make sure that I’m prepared for this in the future as I believed I had 2-3 years before the next one. It felt like all the evidence pointed to this but it didn’t!

Of course, there is always the chance of relapsing. That fear will always be there. But it isn’t necessarily a given. So, I can go easy on myself. Still be ambitious as fuck. On that note, I have stuff to create 🙂

(Still other issues and barriers going on – stuff I’m working on. However, they can wait.)

One thing that really terrified me this year was just how bad the anxiety got before I was even aware that it was beyond the usual symptoms. I’ve identified two of the reasons:

I was in crisis mode for a lot of that time, for reasons beyond my control. Now I’m actively removing myself from any crisis, or even drama.

It was such a gradual decline and was muted somewhat by the medication I was on.

It is possible that this could happen again. The meds might stop working again, or the workload may exacerbate things. I don’t know the new reality.

So, after talking to both my psych and my allied health professional, I’ve decided to come up with a plan of symptoms to look for

Thoughts of suicidal ideation. Crisis or not, that’s not good. If I feel it, or the wrist burning sensation, then I book into the dr. immediately AND bring it up with the psych.

Numb arms. I’m not sure that alone warrants a medical change, but will definitely be noted somewhere. I’m going to create a word document for tracking this, migraines and any other severe symptoms (and anything that worked)

The intense visualizations. That makes me wonder, should I get a different type of medication (prozac?) to knock me out during such severe episodes? Maybe that would be more strategic than changing medication. The point remains. If this is happening frequently, then investigate possible relapse.

Voices, although this time I’m not even sure I heard them, as I’ve read that when talking to yourself in your head the tone can change?

Probably 3 weeks of not being able to do housework. At the moment I go can one week without doing it, but then catch up as soon as I’ve gotten the energy.’

That’s all I have thus far. Having comorbid symptoms (anxiety/depression) makes some monitoring more difficult. I’ll print it out and present to the psych next month and see what he thinks. One concern I have with employment is that there is a high chance of relapse and it feels unethical to seek a job that I may not be able to maintain. However, I have a support team now and they can help me work through those specific concerns 🙂

In 2010, I wrote a little post on my business blog about a concept called the flywheel. Below is an excerpt from that post:

In online business, most people fantasise about The Tipping Point. It’s a concept made famous by Malcolm Gladwell in a book of the same name. It is that magic moment when an idea, trend, or social behaviour crosses a threshold, tips, and spreads like wildfire.

Many people assume that when their online brand takes off, they’re set. That instant popularity will bring instant riches and everything will fall into place.

The reality is more like the flywheel, which is described below.

“Picture a huge, heavy flywheel. It’s a massive, metal disk mounted horizontally on an axle. It’s about 100 feet in diameter, 10 feet thick, and it weighs about 25 tons. That flywheel is your company. Your job is to get that flywheel to move as fast as possible, because momentum — mass times velocity — is what will generate superior economic results over time.

Right now, the flywheel is at a standstill. To get it moving, you make a tremendous effort. You push with all of your might, and finally, you get the flywheel to inch forward. After two or three days of sustained effort, you get the flywheel to complete one entire turn. You keep pushing, and the flywheel begins to move a bit faster. It takes a lot of work, but at last the flywheel makes a second rotation. You keep pushing steadily. It makes three turns, four turns, five, six. With each turn, it moves faster, and then — at some point, you can’t say exactly when — you break through. The momentum of the heavy wheel kicks in your favor. It spins faster and faster, with its own weight propelling it. You aren’t pushing any harder, but the flywheel is accelerating, its momentum building, its speed increasing.”

Jim Collins, Author, Good to Great

Reaching that crucial tipping point is just the start of your transition to successful business owner. You’ve overcome the main hurdle, but you have to keep pushing that flywheel to reach that certain level of momentum.

~

Last night, this concept popped into my head in relation to my recovery from anxiety. I have been so frustrated lately, almost petulant, at how slow recovery is taking. The mind is able but the body sure as heck isn’t willing. I’m making progress but it is incredibly slow. The psychologist got a huge rant at how even though things are improving, everything is all about survival. It’s about getting better. It’s about housework. Getting fit, getting a job.

I believe that it could help to think of it in relation to the flywheel. My psychologist suggested making short and long term plans, just so I could see what I was working towards. The health person at the job network said that everything would be a snowball effect.

I just like taking marketing nerdiness and applying it to a different field 🙂

Last night, I was feeling pretty shit. It’s not uncommon for me to feel like crap, so I thought I’d just ride it out and wait for the meds to properly kick in.

Then it hit me: the meds have kicked in. They’ve worked brilliantly. No more suicidal ideation. No having to spend a weekend distracting myself because I happen to like having feeling in my limbs. I’m staying on top of housework. While I worry a bit, I’m not really having any of the physiological symptoms of anxiety.

This is awesome, and such a relief. The problem is that the anxiety had overpowered everything for so long that I had forgotten I also had depression. I’d forgotten that the symptoms and thought patterns can be different because frankly, mood has always been an afterthought.

Depression explains why some days I have lethargy and some days I’m fine. It explains why I struggle not to cry myself to sleep with guilt (over everything.) It explains why my mind feels fine but my body isn’t complying.

Now, I’m not going to self diagnose. I’ll be talking to my doctor about this, as well as getting a check up to rule out anything else. I know the deal. The pattern seems to fit.

This is kinda good news. By comparison, it is so easy to treat depression with CBT techniques. I can stop the negative thoughts easily. When the anxiety was taking over, I had limited cognitive function which made it more difficult to do any CBT. I was focused on reducing the physical symptoms and was doing a fantastic job at doing this, but it was at the expense of everything else.

I’m not as impacted physically, and I have more brainpower. CBT is so easy in comparison now with all the skills I’ve built up.

This isn’t meant to be bragging. I know that any depressive symptoms are mild and that people will full blown depression can have a similar quality to life to what I had before I started on these meds. This is more of a realization, one that I can use when my brain is beating myself up for the lack of progress over the last month.

I’ll talk to my doctor about medication but be cautious about trying anything. At most, maybe increase the dosage of Pristiq. Too many meds can make it hard to know what is doing what. I’d rather be calm and depressed then full blown anxious.

~

It’s a busy week ahead. A number of mental health appointments. I feel guilty about bitching about them, and being overwhelmed by them, especially when people do demanding 40 hour weeks. One of my struggles is that it forces me to face shit that I’ve been avoiding facing. I have to deal with some massive fears and insecurities. The psych is only every 2-3 weeks and will probably be reduced, but I do a lot of mental work in between sessions. Very little is put on here because it is me working through stuff while on public transport or doing dishes. It’s reading self care posts that trigger me because the exhausted me doesn’t match up with the stuff my brain is doing. The transition is quite triggery, and I don’t have the time to deal with it. The exemption was only for 2-3 months. Anyway, I have stuff to knock off my to-do list

Yeah. So, I had all these plans to post things. Analysis, research, little observations. All of them could have been useful and made for a fascinating record. Alas, I seem to have either fallen into depression or ran out of energy. I’m going to write about things sequentially just so I have some kind of narrative.

I did go owling – and SO paid the price for it

I did go to the other side of Melbourne to look for owls. Heck, I was even right to have the dread. I couldn’t find the hotel in Ringwood. It didn’t correspond with the location on Google maps. I couldn’t understand the guys accent when I phoned for help. The guy at a local car store didn’t help. I had to buy an $18 bloody hat (when I had bugger all in my account) when I realized I didn’t have one. I was crying walking down the street at one point. I got my shit together, found the place and had a ‘sink shower’ in lieu of a normal one. THEN discovered I was spotting, which was another stress I didn’t need.

It turned out okay. My bung knee played up in the car. I got nauseous when driving to the dandenongs, and my tummy was SO grateful for every toilet on the way up and back. Oh, I wasn’t being prissy about not wanting to pee behind a bush. My tummy was massively displeased.

It was so worth it though – it always is. That’s why I’m trying to do this, to rewire my brain. I was so happy seeing the owl, as well as the native fauna on the way back. Being among likeminded minds was so great. I needed it.

I felt like shit for the rest of the week

It’s standard spoon theory. I went out on a trip with the Victorian Field Nats after only 5 hours sleep. It was phenomenal, but I paid the price afterwards. Nearly fell asleep on the train home. Then stupidly got up earlier the next morning to finish editing photos and trying to ID everything.

I ended up feeling really exhausted and braindead, and beating myself up for it. I went out with Glenn for his birthday and had no energy. I was so lethargic. The guilt was overwhelming. On Friday, I ended up crying myself to sleep because I wasn’t up for sex and felt like I had nothing to contribute to the relationship at all. I hadn’t been well enough to do housework, so he had no clean underwear. The lethargy meant I couldn’t do anything. It was incredibly confronting.

What occurred in that hyperactive week so isn’t reality

Knowing and living something are two different things. I knew that the brilliance of that second week wouldn’t last but it still sucked ARSE to crash. My mind is a lot better then usual but the exhaustion has become a constant.

This is so annoying. It’s not so much my mood and worrying that limit me. It’s the cognitive issues and struggles I have with energy. The cognitive issues aren’t as bad but energy has been off for about 2 weeks. I can’t be certain of anything until I’m on the meds for longer but I suspect this may be what it is like in the future.

It’s workable. I may be able to do a couple of 5km walks a week on my good days. I can get more housework done then before. It is better then before. It’s like that one week was taunting me, showing my potential and then taking it away. I was aware of it and had been warned about it. Anyway, not worth thinking about. At the next Dr appointment I can discuss possible medication increase and what I should expect re: energy levels.

I did reconnect with my old GP

One of the reasons I am knackered, I suspect, is because I have been doing a lot of running around. I reconnected with my former GP, the one I saw at Headspace, at the encouragement of my allied health professional. It was great. It was a pain in the arse getting to the neighbouring suburb, especially as buses are only once an hour. I almost cancelled as my tummy was playing up so bad that day. I’m glad I made myself go (and that my tummy was lovely enough to settle down.)

It was so comforting to be around someone who ‘got’ my history. I know the care I’ll be getting will be a lot better now as a result and I’ll have people who can monitor me. It means I wont have to fight as hard when needing help and can have people monitoring me. It means I can relax somewhat when it comes to being the person on top of everything.

I am struggling with the amount of appointments I have

This is scary. I went to a meeting earlier this week to check with the allied health professional at my job network and I just couldn’t remember the relevant names. I got confused, then got scattered trying to explain who was doing what. In reality I’m not seeing that many people. There is the doc, the psych, the allied health professional and the main job network guy. That shouldn’t be overwhelming me.

I’m pinning it on the fact I haven’t been doing lists, journalling etc as much lately and my brain is too full. It doesn’t mean there is cognitive issues or that I’m doing too much. It’s like the drain that gets blocked… hopefully. I’ll be keeping an eye on it.

I feel guilty being overwhelmed at all the appointments when people are working a normal week and doing a lot more then I am, and coping fine. This really concerns me in regards to future employment – especially if I do increase the dosage and don’t iron out the kinks in time :S I want a job, I so badly do, but it needs to be sustainable. Hopefully the job network can help me in that respect.

I’m beating myself up so much

I seem to be doing a lot better but have been so critical of myself. I’m aware of it. I feel like I should be doing more and have more done by now. I feel like people exist in a separate world to me, in the sense that their life is so different to mine. There are no guarantees. There will always be limits. And I have so much I want to do! I’m permanently behind.

It’s a lot easier to get myself out of that state, but I have to feel like it.

~

That is the very abridged version of the past 10 or so days. I know that I’ve lost various insights due to being a slackarse. I can’t focus on that though. I’m like Dory, just keep swimming. And I’m making progress by doing stuff anyway, even though it isn’t 100% what I wanted.